Heavy bleeding (menorrhagia)

Some women naturally have heavier periods than others, but if your periods are so heavy that they impact on your life, there's help available.

Talk to your doctor about your bleeding, including how often you have to change your sanitary protection (towels, tampons or menstrual cup). Your doctor can investigate the cause of the heavy bleeding. These may include blood tests and scans.

The National Institute for Health and Clinical Excellence (NICE) advises that there are a number of possible treatments available. These include:

some forms of hormonal contraception, such as the IUS, implant, injection or combined oral contraceptive pill

In some cases, surgery can be an option if other treatments don’t work, or if there are problems with the womb, such as fibroids (non-cancerous growths). Surgery may include removing fibroids, the lining of the womb, or the womb itself.

Premenstrual syndrome (PMS)

PMS is thought to be linked to changing levels of hormones throughout the cycle. Not all women experience PMS, and among those who do, the range and severity of symptoms can vary.

Severe PMS can disrupt a woman’s personal and work life, making it hard to function in the days before her period.

Symptoms include:

mood swings

irritability

depression

headaches

bloating

breast tenderness

Symptoms appear and can intensify during the second half of the menstrual cycle, and then ease and disappear after the period has started.

The Royal College of Obstetricians and Gynaecologists (RCOG) has useful information on managing PMS.

Some women can benefit from following general health advice, such as eating a healthy balanced diet, reducing alcohol and caffeine intake, and getting regular exercise to keep fit. Cognitive behavioural therapy may help too. This is when a counsellor helps you to recognise negative behaviours and work out strategies to change them. Find out more about counselling.

Various complementary therapies and vitamin supplements claim to help with PMS. While more research is needed, current information seems to show that magnesium and Agnus Castus can help some women.

Some complementary therapies can interact with medication, so get advice from your doctor before starting any.

Sometimes there's an underlying psychological condition that doesn’t go away when the period finishes. This is an indication that it's not a symptom of PMS. In such cases, treatment for the psychological condition may help.

Endometriosis

This is a condition in which cells of the endometrium (the womb lining) appear in other areas of the body. This is usually in the abdominal area, including the pelvis, ovaries and fallopian tubes.

During the menstrual cycle, hormones cause the ovaries to release an egg, and the womb lining to thicken. If the egg isn’t fertilised, the womb lining breaks down and bleeds, and leaves the body as a period. Endometriosis cells elsewhere in the body also break down and bleed, which causes inflammation, pain and adhesions (scar tissue).

Not all women have symptoms, but common symptoms can include:

painful, heavy or irregular periods

pain during or after sex

infertility

problems opening your bowels (passing stools)

These symptoms can signify a range of other conditions. A laparoscopy (a surgical procedure that lets the surgeon look into the abdomen with a small camera) is the only way to make a definite diagnosis.